Tuesday, 14 January 2014

Does your doctor embrace or resist technology?

This is an interesting article published in the NY Times a couple of days ago. It describes a growing trend in the USA for the employment of "scribes" by doctors, to help them complete electronic health records when seeing patients. The article quotes a Dr Sinsky, who researches physician dissatisfaction, as saying "physicians who use scribes are more satisfied with their work and choice of careers.". She goes on to say that scribes offer a triple win: “The patients get undivided attention from the physicians, the scribes are continuously learning while making an important contribution, and the physician gets the satisfaction of doing the work they went into medicine for in the first place.”

Maybe I’ve misunderstood the North American system, but in the UK that’s what junior doctors are for! Consultants (attendings) see patients on the rounds, give their undivided attention to patients, while the juniors scribe and learn from the pearls of wisdom emanating from their seniors. There is no hospital set up in the UK where doctors see patients on their own, it is a team effort. The exception to the rule is in the emergency department, which is the area that the article seems to focus on.

However, there is one simple reason why this will never catch on in the UK: privacy and confidentiality. I believe that patients will simply refuse to have a typist (one without any medical qualifications or training) be present at their consultations.

The other reason this article struck me is that it reveals a belief that technology can only advance healthcare so much, before the human touch needs to be re-instated to recover lost efficiency. I have no idea how the EPR (electronic health records) used by the doctors in the article work, but I am familiar with examples of technology implemented by the UK's NHS which end up falling by the wayside due to a perceived difficulty in using them, when in fact they require some thought and patience and if used properly, can enable substantial efficiency (and cost) savings. The problem, in my opinion, is the prevalance of a "luddite" culture amongst some doctors which holds us back in really grasping the technology available to us to advance our healthcare system.

A simple example is the use of speech recognition technology for radiology reporting. Despite extensive research showing its benefits (increased speed of reporting, faster scan-to-verified report times, improved training for residents), there are radiologists stuck in the past and not willing to embrace this new method. Anyone who has used speech recognition understands that there is a learning curve, both for the user and the software, but the effort pays off as transcription is accurate and speedy. However, the end result is only as good as the user and their ability to not only speak clearly, but be able to review the transcription for errors before signing off.

Technology is supposed to enable us, to empower us and to increase our efficiency. But it also requires willingness, effort and support from users; and most of all, a mindset open to the possibility that humans aren’t necessarily the best tools for all jobs.